Diflucan (fluconazole) vs. Lamisil (terbinafine)

• Diflucan (fluconazole) and Lamisil (terbinafine) are anti-fungal medications used to treat different types of fungal infections.
• Diflucan is used to treat vaginal, oral, and esophageal fungal infections caused by Candida; urinary tract infections, peritonitis, pneumonia and disseminated infections caused by Candida; cryptococcal meningitis; and to prevent Candida infections in patients treated with chemotherapy or radiation after bone marrow transplantation.
• Lamisil oral is used to treat fungal nail infections. Lamisil cream, gel, spray, and solution are used to treat jock itch, ringworm, and athlete’s foot.
• Side effects of Diflucan and Lamisil that are similar include headache, abdominal pain, diarrhea, and changes in taste.
• Side effects of Diflucan that are different from Lamisil include nausea, indigestion, dizziness, low blood potassium (hypokalemia), and rash.
• Side effects of Lamisil that are different from Diflucan include cough, hives, itching, and changes in smell.

Diflucan (fluconazole) is an antifungal medication used to treat vaginal, oral, and esophageal fungal infections caused by Candida; urinary tract infections, peritonitis, pneumonia and disseminated infections caused by Candida; cryptococcal meningitis; and to prevent Candida infections in patients treated with chemotherapy or radiation after bone marrow transplantation. Diflucan works to prevent growth of fungi by preventing production of the membranes that surround fungal cells. Diflucan is related to clotrimazole (Lotrimin), ketoconazole (Nizoral), itraconazole (Sporanox), and miconazole (Micatin, Monistat).

Lamisil (terbinafine) is an antifungal agent taken by mouth or applied to the skin. Lamisil acts by interfering with the ability of fungi to make chemicals called sterols that are an important part of the membrane that surrounds fungal cells and holds them together. This weakens the cell membrane. Oral terbinafine is more effective for treating fungal nail infections than griseofulvin (Fulvicin; Gris-Peg) and itraconazole (Sporanox), two other antifungal agents used for treating fungal nail infections. Lamisil cream, gel, spray, and solution are applied to the skin to treat jock itch, ringworm, and athlete’s foot.

Diflucan

Common side effects of fluconazole include

• headache,
• nausea, and
• abdominal pain.

Other important side effects include

• diarrhea,
• dyspepsia,
• dizziness,
• reduced blood levels of potassium,
• rash, and
• taste disturbance.

Possible serious side effects include

• seizures,
• reduced number of white blood cells,
• reduced number of blood platelets, and
• toxic epidermal necrolysis.

Rarely, serious allergic reactions, including angioedema (swelling of tissues), may also occur. Liver dysfunction (jaundice, hepatitis) and abnormal heartbeats have been associated with fluconazole. Stevens-Johnson syndrome has also been reported.

Lamisil

The most common side effects of terbinafine are:

• headache,
• cough,
• diarrhea,
• abdominal pain,
• hives,
• itching and
• altered taste and smell sensation.

Oral terbinafine can cause liver failure sometimes leading to liver transplantation or death.

Diflucan

• The usual adult dose is 50-400 mg daily depending on the type of infection. Although symptoms of oral Candida infections may subside in a few days, treatment is continued for 2 weeks.
• Esophageal Candida infections are treated for 3 weeks or longer.
• Treatment of cryptococcal meningitis may last for 10-12 weeks after cerebrospinal fluid cultures become negative.

Lamisil

• Tablets: The usual dose is 250 mg once daily for 6 weeks for treatment of the fingernails, and 12 weeks for treatment of toenails. Optimal results will not be seen for several months after treatment because it takes time for new healthy nails to grow. Terbinafine may be taken with or without food.
• Cream, gel, spray, solution: Apply to affected area (s) once (jock itch, ringworm) or twice daily (athletes foot) for about for 1 week.

Diflucan

• Hydrochlorothiazide increases the blood concentration of fluconazole by 40%. However, dosage modification is not recommended when both drugs are combined.
• Rifampin (Rifadin, Rimactane, Rifadin, Rifater, Rifamate) reduces the blood concentration of oral fluconazole, probably by increasing the elimination of fluconazole in the liver; therefore, reducing the effectiveness of fluconazole.
• Fluconazole may increase the concentration of warfarin (Coumadin, Jantoven) in blood by reducing the elimination of warfarin. Therefore, the effect of warfarin may increase, leading to an increased tendency to bleed.
• Fluconazole also increases the concentration of the following drugs in the blood, and as a result, the risk of side effects of these drugs may increase. These drugs include:
  • phenytoin (Dilantin),
  • cyclosporine,
  • zidovudine (Retrovir),
  • saquinavir (Invirase),
  • theophylline (Theo-Dur, Respbid, Slo-Bid, Theo-24, Theolair, Uniphyl, Slo-Phyllin),
  • tolbutamide,
  • glyburide (Micronase, Diabeta, Glynase),
  • glipizide,
  • triazolam (Glucotrol),
  • midazolam (Versed),
  • celecoxib (Celebrex),
  • fentanyl (Sublimaze),
  • atorvastatin (Lipitor),
  • simvastatin (Zocor), and
  • lovastatin (Mevacor).
• As a result, the risk of side effects from the above drugs may increase.
• Combining fluconazole with amiodarone (Cordarone), pimozide (Orap), bepridil (Vascor) or other drugs that affect heart rhythm may increase the risk of abnormal heart rhythms.

Lamisil

Rifampin reduces oral terbinafine blood concentrations, potentially reducing the efficacy of terbinafine. Cimetidine (Tagamet) may increase oral terbinafine blood levels, potentially increasing side effects of terbinafine. Fluconazole (Diflucan) increases the blood levels of oral terbinafine by 52%-69%. Potentially leading to increased side effects.

Diflucan

• There are no adequate studies of Diflucan in pregnant women. There are reports of harmful effects to the fetus when high dose fluconazole was administered to pregnant women for a few months. Use of fluconazole during pregnancy is not recommended.
• Diflucan is secreted in breast milk at concentrations similar to the mother's blood level. However, fluconazole is used for treating neonates with fungal infections and for treating lactation associated Candida infections. Available evidence suggests that use of fluconazole during breastfeeding has little risk.

Lamisil

• There are no adequate studies in pregnant women. Since nail fungus treatment can be delayed until after pregnancy there is no reason to use oral terbinafine during pregnancy.
• Breastfeeding mothers should not use oral terbinafine because terbinafine passes into breast milk.